Types of Hormonal and Menstrual Migraines
Hormonal headaches can present in several forms, each influenced by changes in hormone levels during the menstrual cycle.
Pure Menstrual Migraine:
Pure menstrual migraine is characterised by migraine attacks that occur only in close proximity to menstruation—specifically, from two days before to three days after the onset of a period (known as day 1 ± 2). These migraines do not appear at any other point in the menstrual cycle. For a formal diagnosis, this pattern must be consistent, occurring in at least two out of three consecutive cycles. While symptoms like intense, throbbing head pain, nausea, and sensitivity to light or sound are common, the defining feature is their strict timing around menstruation. This form of migraine is relatively uncommon but often more predictable due to its clear hormonal trigger.
Menstrually Related Migraine:
Menstrually related migraine also occurs during the day 1 ± 2 window of menstruation, but with additional migraine attacks happening at other times throughout the cycle. This makes it more prevalent and sometimes more difficult to diagnose without long-term symptom tracking. The migraine attacks may still follow a hormonal pattern but are also influenced by other triggers such as stress, poor sleep, or dietary factors. Diagnosis typically requires confirmation that menstrual migraines have occurred in at least two out of the last three cycles, with careful observation over time. These migraines can vary in presentation, sometimes involving aura or other neurological symptoms in addition to the classic throbbing pain.
Other Hormonal Headaches:
Hormonal headaches can also occur due to other hormonal changes, such as during pregnancy, perimenopause, menopause, or while using hormonal birth control methods like birth control pills. Fluctuations in oestrogen levels are a key trigger. These headaches often mimic migraine headaches and may include severe pain, visual disturbances, and neck pain. Monitoring symptoms with a headache diary can help track patterns and identify hormonal links.
Understanding the type of hormonal headache experienced is essential for effective hormonal migraine treatment and menstrual migraine prevention strategies.
History of Hormonal Headache / Menstrual Migraine
Hormonal Headache was originally thought to be due to abnormal levels of hormones throughout the body. During a normal menstrual cycle, oestrogen levels in the body drop.
It was previously thought that the drop in oestrogen levels was the cause of hormonal headaches. This was proven false, as several studies have found that the drop in oestrogen levels did not significantly differ from those with hormonal headaches, than those without this condition.
Leading experts in this field have found that there is in fact no hormonal abnormalities to trigger hormonal headaches.
Traditional Approaches to Hormonal Migraine Treatment
Traditional strategies for treating menstrual migraines often aim to manage symptoms rather than address potential underlying causes. Common approaches include the use of migraine medication, non-steroidal anti-inflammatory drugs (NSAIDs), and hormone replacement therapy (HRT). These options may provide temporary relief but can carry risks such as medication overuse or side effects linked to hormone therapies.
Many women are prescribed birth control pills or other methods to regulate hormone fluctuations in hopes of preventing period headaches. However, these treatments can sometimes lead to breakthrough bleeding or unintended hormonal side effects, especially in those with migraine with aura, where certain contraceptives may not be recommended.
Other options might include lifestyle adjustments, dietary changes, and tracking symptoms through a headache diary. While these can assist with identifying potential triggers, they often don’t resolve the core issue for those suffering from a sensitised brainstem.
While these treatments may offer relief for some, they may not work for everyone – particularly those whose migraines are linked to neural sensitisation rather than solely hormonal fluctuations. That’s why at Sydney Headache and Migraine Clinic™, our focus remains on comprehensive assessment and treatment targeting the brainstem, aiming to provide long-term relief without the reliance on medications or hormonal manipulation.
What causes hormonal migraine?
Hormonal migraine is closely associated with fluctuations in oestrogen levels throughout the menstrual cycle. However, research indicates that it is not simply the drop in oestrogen itself that causes migraine. Many women experience identical hormonal changes without developing headaches.
Current understanding suggests that hormonal changes act as a trigger in individuals with an already sensitised nervous system. In those with increased brainstem sensitivity, normal physiological fluctuations may be amplified, leading to migraine symptoms.
How long does a hormonal or menstrual migraine last?
A hormonal or menstrual migraine typically lasts between 4 and 72 hours, although attacks may persist longer if not treated early. These migraines are often reported to be more severe and more resistant to standard medication than migraines occurring outside the menstrual window.
Because the hormonal influence may sustain neurological sensitivity during this period, early intervention is important.
Why are menstrual migraines often more severe?
Menstrual migraines are frequently described as more intense, longer lasting, and harder to treat. This may be due to the interaction between hormonal change and an already sensitised trigemino-cervical system.
When the brainstem is hyper-responsive, even normal hormonal fluctuations can lower the threshold for migraine activation. This heightened responsiveness may explain why attacks during menstruation can feel more debilitating than those triggered by other factors.
How can hormonal migraine be prevented?
Prevention strategies may include:
- Tracking menstrual cycles to identify predictable vulnerability windows
- Maintaining consistent sleep and meal timing
- Managing stress load
- Short-term perimenstrual medications prescribed by a GP or neurologist
At Sydney Headache and Migraine Clinic™, prevention also involves assessing and addressing neural sensitisation. By targeting irritation within the upper cervical spine and its connection to the trigemino-cervical nucleus, the aim is to reduce overall migraine susceptibility rather than simply suppress symptoms.
Does menopause affect hormonal migraine?
Migraine patterns often shift during perimenopause due to fluctuating hormone levels. Some women experience worsening symptoms during this transitional phase.
Following menopause, when hormonal levels stabilise, many women notice a reduction in hormonally associated migraine attacks. However, if central nervous system sensitisation remains, migraine can persist independent of hormonal cycling.
Are hormonal migraines always caused by hormones alone?
No. While hormonal fluctuations may act as a trigger, they are rarely the sole cause. The presence of migraine reflects an underlying neurological predisposition.
Understanding whether migraine attacks are primarily hormonally timed, cervicogenic in origin, or driven by broader neural sensitisation is essential for effective long-term management.
